Simplification of Empiric Therapy for the Febrile, Neutropenic Oncology Patient

Abstract

Empiric therapy for the neutropenic oncology patient with unexplained fever appears quite complicated to the uninitiated. However, as is the case with the game of chess, once a few basic rules are learned, a handful of principles are comprehended and a set of opening moves that have passed extensive field testing are adopted, empiric therapy of febrile, neutropenic cancer patients can be surprisingly straightforward in many respects. Management strategy is virtually independent of the patient’s age. The variety of organisms that commonly infect the neutropenic host is limited (Table 1). The usual sites of infection are few: the periorbital tissues, sinuses, oral and gastrointestinal mucosa, pharynx, cervical nodes, lungs, liver, spleen, kidneys, perirectal tissues, and skin, particularly at catheter exit sites and biopsy sites. The most daunting aspect of the management of the neutropenic cancer patient is, ironically, selecting empiric therapies from the large array of available antimicrobial agents and adjuvant therapies. The other common pitfall in treating infectious complications in neutropenic cancer patients is failure to recognize that management of these patients is a unique aspect of the practice of infectious diseases.